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Cardiovascular involvement by osteosarcoma: an analysis of 20 patients

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Abstract

Background

Although hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom reported and can be difficult to recognize. The enhanced resolution of modern CT and MRI scanners may lead to better detection of cardiovascular involvement.

Objective

To describe the key imaging findings and clinical behavior of cardiovascular involvement by osteosarcoma.

Materials and methods

We retrospectively reviewed the imaging findings and clinical characteristics of 20 patients with cardiovascular involvement by osteosarcoma identified by two pediatric radiologists from a review of imaging studies at our institution from 2007 to 2013.

Results

At initial diagnosis, the median age of the patients was 15.1 years (range 4.8–24.6 years), and 7 (35%) patients had detectable metastases. Median time to detection of cardiovascular metastases was 1.8 years (range 0–7.3 years). Sixteen patients died of disease; 4 have survived a median of 7.4 years since initial diagnosis. The sites of cardiovascular involvement were the systemic veins draining the primary and metastatic osteosarcoma, pulmonary arteries, pulmonary veins draining the pulmonary metastases, and heart. A dilated and mineralized terminal pulmonary arteriole is an early sign of metastatic osteosarcoma in the lung. Unfamiliarity with the imaging features resulted in under-recognition and misinterpretation of intravascular tumor thrombus as bland thrombus.

Conclusion

Knowledge of imaging findings in the era of modern imaging modalities has enhanced our ability to detect cardiovascular involvement and lung metastases early and avoid misinterpreting tumor thrombus in draining systemic veins or pulmonary arteries as bland thrombus.

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Acknowledgments

We are grateful to Nancy E. Fitzgerald, MD, a pediatric radiologist formerly at MD Anderson Cancer Center, for generously contributing the vast majority of the cases reviewed in this study. Most of the imaging findings illustrated in this manuscript are her observations.

This study is supported by the NIH/NCI under award number P30CA016672.

This study was presented in part as a scientific informal poster at the Radiological Society of North America annual meeting in December 2013.

Conflicts of interest

None

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Authors and Affiliations

  1. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, MDT Boone Pickens Academic Tower, 1400 Pressler St., Unit 1473, Houston, TX, 77030, USA

    Sireesha Yedururi, Ajaykumar C. Morani & Gregory W. Gladish

  2. Department of Internal Medicine, Medstar Harbor Hospital, Baltimore, MD, USA

    Srilakshmi Vallabhaneni

  3. Department of Pediatrics Hematology/Oncology/BMT, Carolinas Healthcare System, Levine Children’s Hospital/Levine Cancer Institute, Charlotte, NC, USA

    Peter M. Anderson

  4. Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Dennis Hughes & Najat C. Daw

  5. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Wei-Lien Wang

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  1. Sireesha Yedururi
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  3. Gregory W. Gladish
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Correspondence to Sireesha Yedururi.

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Yedururi, S., Morani, A.C., Gladish, G.W. et al. Cardiovascular involvement by osteosarcoma: an analysis of 20 patients. Pediatr Radiol 46, 21–33 (2016). https://doi.org/10.1007/s00247-015-3449-y

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  • DOI: https://doi.org/10.1007/s00247-015-3449-y

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